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withdrawal form

If you want to cancel the contract, please fill out this form and send it back.

To

ALIVE collective/Effizienta OHG
Lindwurmstraße 104
80337 Munich
Germany
fax: 0049 89 125 95 2449
e-mail: sabine.zywietz@effizienta.com

I/we (*) hereby revoke the contract concluded by me/us (*) for the purchase of the following goods (*)/the provision of the following service (*)

_______________________________________________________

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Ordered on (*) ____________ / received on (*) __________________

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Name of the consumer(s)

________________________________________________________
Address of the consumer(s)

________________________________________________________
Signature of the consumer(s) (only in case of communication on paper)

_________________________
Date

(*) Delete as applicable